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Meta-Analysis
. 2019 Aug 28;19(1):121.
doi: 10.1186/s12893-019-0587-4.

Pancreaticoduodenectomy versus limited resection for duodenal gastrointestinal stromal tumors: a systematic review and meta-analysis

Zefeng Shen  1 , Ping Chen  2 , Nannan Du  1 , Parishit A Khadaroo  3 , Danyi Mao  4 , Lihu Gu  5
Affiliations
Meta-Analysis

Pancreaticoduodenectomy versus limited resection for duodenal gastrointestinal stromal tumors: a systematic review and meta-analysis

Zefeng Shen et al. BMC Surg. .

Abstract

Background: By comparing the long-term prognostic outcomes after pancreaticoduodenectomy (PD) and limited resection (LR), this study aimed to investigate the optimal surgical modality for duodenal gastrointestinal stromal tumors (GISTs).

Methods: Two authors independently searched PubMed, Web of Science, Embase, and the Cochrane Library for published articles comparing the long-term prognostic and clinicopathological factors of duodenal GIST patients undergoing PD versus LR. Relevant information was extracted and analyzed.

Results: After screening, 10 items comprising 623 cases were eventually included. This meta-analysis explicitly indicated that PD treatment was associated with worse long-term prognosis (hazard ratio = 1.93; 95% confidence interval [CI], 1.39-2.69; p < 0.001; I2 = 0) and more complications (odds ratio [OR] = 2.90; 95% CI, 1.90-4.42; p < 0.001; I2 = 10%) than LR treatment. Nevertheless, for duodenal GISTs, PD was related to the following clinicopathological features: invasion of the second part of the duodenum (OR = 3.39; 95% CI, 1.69-6.79; p < 0.001; I2 = 50%), high-degree tumor mitosis (> 5/50 high-power fields; OR = 2.24; 95% CI, 1.42-3.52; p < 0.001; I2 = 0), and high-risk classification (OR = 3.17; 95% CI; 2.13-4.71; p < 0.001; I2 = 0).

Conclusions: Since PD is associated with worse long-term prognosis and more complications, its safety and efficacy should be ascertained. Our findings recommend the use of LR to obtain negative incision margins when conditions permit it.

Keywords: Duodenal gastrointestinal stromal tumors; Limited resection; Meta-analysis; Pancreaticoduodenectomy; Prognosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of literature screening process
Fig. 2
Fig. 2
Forest plot comparing the long-term prognostic outcomes of pancreaticoduodenectomy (PD) and limited resection (LR)
Fig. 3
Fig. 3
Egger’s funnel plot for publication bias test comparing the curative effects of the different surgical groups
See this image and copyright information in PMC

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